to the list of reviews
A warning sign may be cardiotographic abnormalities,
with a vaginal examination confirming diagnosis. It
is important to prevent compression of the cord by
the fetal head during contractions. Syntocinon must
be turned off and tocolytics considered in the case
of hyperstimulation. Manoeuvres available are the all
fours or left lateral position, with an assistant's
hand in the vagina to prevent the head compressing
the cord. The cord should be kept moist or replaced
if prolapsing out of the vagina. Oxygen is administered
to the mother. Delivery is then advocated, either by
expedient forceps or ventouse, or by caesarean section
if the cervix is not fully dilated. Monitoring is crucial
to prevent heroic procedures after fetal demise.
An alternative method of management is to fill the
maternal bladder with 400-700mls of saline. This has
a two-fold effect: 1. it elevates the head from the
pelvic brim, reducing cord compression; 2. it has a
tocolytic effect on the uterus. A caesarean section
can then be performed with less haste. We found only
two reports on this method, which describe a total
of 75 cases with no perinatal deaths (4,5).
These studies were however uncontrolled, and we do
not know how many instances of cord prolapse occur
overall, and how many of these result in perinatal
death with conventional management. The apparent low
number of deaths (n=13) associated with cord prolapse
in the West Midlands over the last 5 years would suggest
that conventional methods of management are also effective.
However a protocol using bladder filling would seem
particularly useful for longer delays, as when transferring
from a home delivery to hospital.
1. Koonings P. Umbilical cord prolapse. The Journal
of Reproductive Medicine. 1990;35(7):690-2, Abstract
2. Murphy DJ, MacKenzie IZ. The mortality and morbidity associated with umbilical
cord prolapse. Br J Obstet Gynaecol. 1995;102:826-30, Abstract
3. Mesleh R. Umbilical cord prolapse. Journal of Obstetrics and Gynaecology.1993;13:24-8.
4. Katz Z. Management of labor with umbilical cord prolapse: a 5 year study.
Obstetrics & Gynaecology. 1988;72(2):278-81, Abstract
5. Chetty RM. Umbilical cord prolapse. South African Medical Journal. 1980;57(4):128-9, Abstract